Updated Edition!
This story of a woman suffering from early-stage breast cancer is in many ways remarkable. After being diagnosed, she scheduled consultations with surgeons but, because it was the holiday season, appointments were delayed. She therefore decided to use the time proactively and arranged a consultation with ‘Dr. T,’ an integrative medical doctor. She wanted to explore if supplements could support her health while I waited for treatment.
Dr. T mentioned another holistic practitioner, ‘Dr. D’, who specialized in thermography, a thermal imaging technique that maps blood flow on the breast’s surface. Dr. D had allegedly “healed” a breast cancer patient without surgery, radiation or chemotherapy. The patient was intrigued and made an appointment with Dr. D. and had a thermogram.
This involved nine thermal images taken with a special camera, followed by a “cold challenge” where the patient submerged her hands in icy water. She was told that healthy tissue cools in sync with the brain’s signals, while cancerous tumors show up as hot spots.
Discussing the findings with the patient, Dr, D. explained that the thermography had not detected a breast cancer; it it had only revealed “extra heat” in the area. This, the doctor explained, would put her in the “high-risk” category. He explained further that cancer was caused by “too many COVID vaccines,” and therefore the patient shouldn’t get another. “What about the fact that my mom had the same type of cancer, in the same breast, at the same age?” She asked in disbelief. “No, it’s definitely the vaccines,” the doctor insisted, before pivoting to his next pitch: Super Mineral Water, a product he sold in his clinic, which he claimed could “detox” the patient’s body and possibly help cure her.
At this point, the patient, who happened to be a science writer by profession, was horrified and embarrassed — not just by the quackery, but also by her own naiveté for walking into this mess. She took the only sensible action possible: she grabbed her things and left as quickly as she could.
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When we discuss so-called alternative medicine (SCAM), we regularly forget alternative diagnostic methods. Thermography might be counted as one of them, particularly when it is used for diagnosing cancer. A systematic review of the evidence concluded that currently there is not sufficient evidence to support the use of thermography in breast cancer screening, nor is there sufficient evidence to show that thermography provides benefit to patients as an adjunctive tool to mammography or to suspicious clinical findings in diagnosing breast cancer.
The danger with alternative diagnostic methods are mainly twofold.
- False positive diagnoses (FPD): this means a clinician uses an alternative diagnostic technique and concludes that the patient is suffering from disease xy, while she is, in fact, healthy. FPDs usually prompt lengthy treatments. They thus cause harm by firstly prompting worries and secondly expence.
- False negative diagnoses (FND): this means a clinician uses an alternative diagnostic technique and concludes that the patient is healthy, while she is, in fact, ill. FNDs prompt the patient to no treat her condition in a timely fashion. This can cause untold harm, in extreme cases even death.
In the case above, Dr, D. tried to combine the two options. He issued a FND that could have cost the patient’s life. Simultaneously, he made a FPD that was aimed at filling his pocket.
The story has fortunately a happy ending. After escaping the quack doctor, the patient received proper treatment and made a full recovery.
Reflexology (originally called ‘zone therapy’ by its inventor) is a manual technique where pressure is applied to the sole of the patient’s foot (and sometimes also other areas such as the hands or ears). It must be differentiated from a simple foot massage that is agreeable but makes no therapeutic claims beyond relaxation. Reflexology is said to have its roots in ancient cultures. Its current popularity goes back to the US doctor William Fitzgerald (1872–1942) who did some research in the early 1900s and thought to have discovered that the human body is divided into 10 zones each of which is represented on the sole of the foot.
Reflexologists thus drew maps of the sole of the foot where all the body’s organs are depicted. Numerous such maps have been published and, embarrassingly, they do not all agree with each other as to the location of our organs on the sole of our feet. By massaging specific zones which are assumed to be connected to specific organs, reflexologists believe to positively influence the function of these organs. Reflexology is mostly used as a therapy, but some therapists also claim they can diagnose health problems through feeling tender or gritty areas on the sole of the foot which, they claim, correspond to specific organs.
The assumptions made by reflexologists contradict our current knowledge of anatomy and physiology and are thus not biologically plausible. Reflexology has been submitted to clinical trials in numerous different conditions. A systematic review concluded that “the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition.” Recent review tend to be more positive suggestin, for instance, that foot reflexology produced significant improvements in sleep disturbances , or that reflexology may provide additional nonpharmacotherapy intervention for adults suffering from depression, anxiety, or sleep disturbance. However, due to the poor quality of most of the primary studies, such statements must be interpreted with caution.
[references see my book]
This randomized clinical trial investigated the effect of foot reflexology on the sexual function of lactating women. It was conducted in selected health centers of Isfahan in 2022 on 64 lactating women (32 women in each group of intervention and control). The samples were selected using the convenience sampling method and were randomly divided into two groups using a random number table. Each participant in the intervention group received 10 sessions of foot reflexology, and each session lasted for 50 minutes (25 minutes for each foot) and was held every three days. The female sexual function index (FSFI) questionnaire was completed by all participants before the intervention and four weeks after the end of the treatment period. The control group received routine care and completed the questionnaire before the intervention and 9 weeks later. Data were analyzed using SPSS version 20 and independent/paired t-tests.
Results showed that the subjects of the two groups were homogeneous in demographic and fertility characteristics at the beginning of the study. The total mean score of sexual function in the intervention group was 20.36 ± 4.16 before the intervention and 28.05 ± 2.89 after the intervention. In the control group, this score was 20.51 ± 3.75 before the intervention and 20.54 ± 3.71 nine weeks after it. A comparison of the total mean score of sexual function and dimensions showed a significant difference between the two groups four weeks after the intervention (p <0.001). In the intervention group, significant changes were observed in the total mean score of sexual function and its dimensions four weeks after the intervention compared to before the intervention. However, in the control group, there were no significant changes in this score and its dimensions nine weeks later compared to before the intervention.
The authors concluded that lactating women in the two groups did not have a desirable sexual function before the intervention. However, foot reflexology in the present study could effectively improve the sexual function of women in the reflexology group. Therefore, it is recommended to employ foot reflexology therapy in health centers to help lactating women restore their sexual function.
This conclusion might hold if we assume that firstly reflexology was a plausibe therapy (which it is not, see above) and secondly postulated that patient-blinding and placebo effects (features that the present trial did not have) are unimportant in such a study. Yet, the latter assumption cannot be true. A total of 500 minutes of a foot massage must surely prompt a placebo response! Therefore, the notion that the reflexology treatment caused the observed outcomes is unwarranted – almost certainly the effects were mainly due to placebo.
So, what we have here is a hugely over-optimistic conclusion, something we all long got used to in the realm of so-called alternative medicine (SCAM). But far worse, in my view, is the fact that the authors do not even leave it at that. They also issue a gerneral and far-reaching recommendation for foot reflexology as a means for restoring sexual function to lactating women.
This is not just poor science, it is stupid and irresponsible!
I was fascinated and horrified in equal measure to watch Donald Trump speaking at the CPAC talking about a medical topic – autism to be precise. Here are his words (minus the gibberish he always adds to disguise the stupidity of his phrases):
…15 years ago, there was one case per 10 000, some say 20 000 US citizens. Now the figure is 1 in 36. There’s something wrong. Bobby (Robert F. Kennedy Jr.) is gonna find it, working with Dr. Oz; by the way, working with Dr. Oz…
The audience of conservatives cheered blissfully!
What Trump said at the CPAC was not original. He uttered almost identical nonsense before (except he also claims the rate is now 1 in 34); it seems to be one of his set pieces for amusing the intellactually challenged.
A few days ago Trump signed an executive order (EO) calling for the creation of a ‘Make America Healthy Again’ Commission, which the White House says will be “tasked with investigating and addressing the root causes of America’s escalating health crisis.” In the EO, the figures are, however, a little different: “Autism spectrum disorder now affects 1 in 36 children in the United States — a staggering increase from rates of 1 to 4 out of 10,000 children identified with the condition during the 1980s.”
- 15 years ago was not the 1980s;
- 1 in 10 000 is not the same as 1 to 4 out of 10,000 children.
But, as we are often told, we must not take Trump literally; it’s the ‘BIG PICTURE’ that counts!
A little research reveals that the 1 in 36 prevalence figure originates from this survey. It was not focussed on autism but on autism spectrum disorder (ASD).
- Autism is a specific disorder within the broader category of ASD.
- ASD refers to a range of conditions that share some commonalities.
- Autism has distinct characteristics and symptoms.
- ASD includes conditions like autism, Asperger’s syndrome, childhood disintegrative disorder, and an unspecified form of pervasive developmental disorder.
Is it really too difficult for Trump to differentiate between autism and ASD?
Or is the reason that this would not fit his agenda?
The survey concluded that “findings from the ADDM Network 2020 surveillance year indicate higher ASD prevalence than previous estimates from the ADDM Network and continuing evidence of a marked shift in the demographic composition of children identified with ASD compared with previous years. Although earlier ADDM Network reports have shown higher prevalence among higher-SES White children compared with other groups, the latest data indicate consistently higher prevalence among Black and Hispanic children compared with White children, and no consistent association between ASD and SES. Furthermore, this is the first ADDM Network report in which the prevalence of ASD among girls has exceeded 1%. Since 2000, the prevalence of ASD has increased steadily among all groups, but during 2018–2020, the increases were greater for Black and Hispanic children than for White children. These data indicate that ASD is common across all groups of children and underscore the considerable need for equitable and accessible screening, services, and supports for all children.”
The authors of the survey caution that the findings in their report are subject to at least seven limitations.
- First, the methods rely on the availability, quality, and completeness of existing information and records to ascertain ASD cases and other indicators. Although all sites had access to special education classification data, certain sites did not have access to education records for their entire population, limiting the ability to identify children with ASD exclusively identified and served through their schools. Sites requested records from public school special education programs but did not review private school education records. Incomplete information could lead to misclassifying children’s cognitive ability, overestimating the age when they were first evaluated or when ASD was diagnosed, or failing to ascertain that the children were identified as having ASD. Sex information reflects what is represented in children’s records and might not reflect their gender identity.
- Second, the case definition for intellectual disability was measured using a child’s latest cognitive test or examiner statement of a child’s cognitive ability. Diagnostic and special education eligibility criteria for intellectual disability requires concurrent adaptive functioning deficits. IQ scores are not necessarily stable measures of intellectual ability over time, can increase among children with ASD in response to intensive early therapeutic interventions, and might be unstable during early childhood. The age at which children had their most recent test or examiner impression of cognitive ability varied by site.
- Third, the ADDM Network sites are not intended to be representative of the states in which the sites are located. ADDM Network sites are selected through an objective and competitive process, and findings do not necessarily generalize to all children aged 8 years in the United States. Interpretations of temporal trends can be complicated by changing surveillance areas, case definitions, data source access, and diagnostic practices.
- Fourth, small numbers result in imprecise estimates for certain sites and subgroups, and estimates falling below the selected threshold for statistical precision were suppressed.
- Fifth, the surveillance data system does not collect the number of ASD ICD codes a child received at a specific source, limiting comparability to analyses of claims/billing databases that consider number of ICD codes received.
- Sixth, the COVID–19 pandemic resulted in reduced access to records from some sources at certain sites; it was often possible to electronically obtain some data elements from these sources but not manually review the full contents of records. Disruptions in services and school closures during 2020 might have resulted in less documentation of ASD in records, which could decrease ASD ascertainment by ADDM sites.
- Seventh, the prevalence of undetected ASD in each community as well as false-positive ASD diagnoses and classifications are unknown.
So, Trump charged Robert F. Kennnedy Jr. to investigate why ASD is on the increase. As it happens, Kennedy already knows the conclusion of this investigation. He has often stated widely debunked claims that autism is caused by vaccinations. For instance, in a 2023 interview with Fox News, he squarely claimed that “autism comes from vaccines”. This theory was popularised by the discredited ex-doctor Andrew Wakefield based on a fraudulent paper that was later retracted by the Lancet. Multiple studies have subsequently demonstrated that there is no link between vaccines and autism.
Luckily Kennedy has Dr. Oz – yes the very Dr. Oz who has featured many times on my blog (see for instance here, here and here) – to help him get to the bottom of what Trump believes to be a mystery. Those two will be quite an unbeatable team (neither of them has ever done proper research in this area; Oz promotes any quackery that fills his pockets, and Kennedy would not recognise reliable science, if it bit him in his behind)! Perhaps they could start their investigation by reading the many papers that have already found at least some of the plausible reasons for the above-cited figures, e.g:
- The Real Reasons Autism Rates Are Up in the U.S. | Scientific American
- Is Autism Really Increasing?
- Factors Causing an Increase in Autism | Psych Central
- Autism: Cases on the Rise; Reason for Increase a Mystery
- Recognising autism in healthcare – PubMed
Oh, I almost forgot: they don’t need to read such demanding papers. They already have the answer to the autism mystery!
PS
- acupuncture (39%),
- aromatherapy (35%),
- creative arts (20%),
- massage therapy (5%)
- hypnosis (1%).
After SCAM treatments, heart rate decreased and symptom scores improved for anxiety, fatigue, nausea, pain, and sadness (Cohen’s d effect sizes 0.22-0.99). Adjusted mixed-effects models suggested that the Faces Scale scores improved over time (b= -0.19, p<.01).
- after SCAM treatments, heart rate decreased and symptom scores improved for anxiety, fatigue, nausea, pain, and sadness;
- adjusted mixed-effects models suggested that the Faces Scale scores improved over time.
Of note is that they formulate these findings cleverly. Yet, the language nevertheless implies that SCAM was the cause of the observed effects.
To this I object!
In fact, I postulate that the findings show that SCAM treatments :
- delayed improvements in heart rate decreased, symptom scores, anxiety, fatigue, nausea, pain, and sadness.
- hindered the Faces Scale scores from improving over time.
On what grounds, you ask?
As the study had no control group, the basis for my claim is just as solid as the suggestions of causality made by the authors!
Hair loss is prevalent and can affect both males and females of different age groups. Despite the availability of many conventional treatment options, these might cause side effects, leading to a growing interest in natural and herbal remedies (HRs).
This review aimed to investigate the efficacy and safety of various HRs for hair loss and examine the current scientific evidence behind them. A literature search identified relevant studies published up to March 2024. The results suggested potential benefits in promoting hair growth and treating various forms of hair loss (HL). Several remedies were found to be effective in different conditions, including:
- androgenetic alopecia (AGA),
- telogen effluvium,
- alopecia areata (AA).
Various mechanisms of action (MOA) seem to be involved,
including
- 5α-reductase inhibition,
- increased microcapillary blood flow,
- antioxidant effects,
- modulation of the hair growth signaling pathways.
The authors concluded that natural and herbal remedies show promise in treating hair loss, However, many of these studies have limitations such as lack of long-term follow-up, small sample sizes, and short treatment durations. Due to this variation in the quality of evidence, further well-designed randomized trials with larger sample sizes are required to confirm the efficacy of these HRs.
The herbal remedies included in this review are:
- rosemary,
- saw palmetto,
- onion juice,
- Korean red ginseng,
- pumpkin seed oil,
- azelaic acid,
- olive oil,
- coconut oil,
- henna,
- honey,
- rice bran extract,
- Ashwagandha,
- Amla.
The authors claim that they “show promise”. Is it ‘splitting hair’ to ask: all of them? Closer inspection finds significant ‘hair in the soup’ and reveals that this statement is ‘pulled by the hair’ and based largely on wishful thinking. The truth is that evidence from rigorous clinical trials is almost totally absent.
I am tempted to say that this review is ‘hair-raising’ – alas there is not much hair left on my head to raise – even for a review as poor and misleading as this one.
In case you are new here and don’t know, the ‘ALTERNATIVE MEDICINE HALL OF FAME’ is an illustrious group of people researching so-called alternative medicine (SCAM). They have been elected [by myself] for one main reason: they have managed to go through their entire carrer publishing nothing but positive results related to their ‘pet SCAM’.
So far, the group consists of:
- Josef M Schmid (homeopathy, Germany)
- Meinhard Simon (homeopathy, Germany)
- Richard C. Niemtzow (acupuncture, US)
- Helmut Kiene (anthroposophical medicine, Germany)
- Helge Franke (osteopathy, Germany)
- Tery Oleson (acupressure , US)
- Jorge Vas (acupuncture, Spain)
- Wane Jonas (homeopathy, US)
- Harald Walach (various SCAMs, Germany)
- Andreas Michalsen ( various SCAMs, Germany)
- Jennifer Jacobs (homeopath, US)
- Jenise Pellow (homeopath, South Africa)
- Adrian White (acupuncturist, UK)
- Michael Frass (homeopath, Austria)
- Jens Behnke (research officer, Germany)
- John Weeks (editor of JCAM, US)
- Deepak Chopra (entrepreneur, US)
- Cheryl Hawk (chiropractor, US)
- David Peters (osteopathy, homeopathy, UK)
- Nicola Robinson (TCM, UK)
- Peter Fisher (homeopathy, UK)
- Simon Mills (herbal medicine, UK)
- Gustav Dobos (various SCAMs, Germany)
- Claudia Witt (homeopathy, Germany/Switzerland)
- George Lewith (acupuncture, UK)
- John Licciardone (osteopathy, US)
Inspired by my post from yesterday which focussed on a study by NAFKAM, I had a look at the director of this institute, Miek C Jong. Her pet SCAM seems to be homeopathy. She has published, as far as I can see, 4 clinical trials and two reviews of homeopathy (in case I have missed any, please let me know). Here are the links and key sentences from all of these papers:
CLINICAL TRIALS
- …the added value of homeopathy compared with usual care was demonstrated by significant differences in symptom score changes…
- An integrative treatment approach where SilAtro-5-90 (a homeopathic product) is given alongside mainstream symptomatic treatment may bring therapeutic benefit to patients suffering from recurrent tonsillitis.
- Both complex homeopathic products led to a comparable reduction of URTIs.
- In primary care, homeopathic treatment for acute respiratory and ear complaints was not inferior to conventional treatment.
REVIEWS
- This meta-analysis revealed that the proportion of patients experiencing adverse effects was significantly higher when receiving conventional medicine and herbs, compared to patients receiving homeopathy.
- Our systematic evaluation demonstrated that the reporting rate of ADRs associated with anthroposophic and homeopathic solutions for injection is very low.
I hope you agree that publishing all these homeopathy-papers without even a hint of a negative finding is a remarkable effort (bearing in mind that trials of highly diluted homeopathic remedies are, in fact, testing one placebo against another) In my view, this achievement is so remarkable that, today, I take the pleasure to admit Miek Jong into my ALTERNATIVE MEDICINE HALL OF FAME.
WELCOME MIEK!
- spiritual healing alongside usual care (n = 14);
- or usual care alone (n = 14).
The healing sessions were highly individualized. The healer positioned her hands over various areas of the client’s body (head, chest, knee, hip, and feet) intending to adjust the energy flow within the client. Outcomes were measured by changes in the Beck Depression Inventory for Primary Care (BDI) scores pre-and post-intervention. Participants’ experiences with spiritual healing were explored through a process evaluation.
- A pilot study is for testing the feasibility and not for calculating outcomes.
- In any case, this was not a pilot study but an effectiveness trial that failed because of recruitment difficulties.
- As it followed the infamous ‘A+B versus B’ design that produces a positive result even for a placebo treatment, the study (if we disregard the small sample size and take its findings seriously) merely shows that placebo can be effective.
- The conclusion is therefore wrong and should read: spiritual healing causes a placebo response in individuals who suffer from moderate depression.
- The National Research Center of Complementary and Alternative Medicine (NAFKAM), Faculty of Health Science, Institute of Community Medicine, The Arctic University of Norway which seems to be the main institution responsible for this nonsense should be questioned how they justify spending money and time on such pseudoscience.
This double-blind, randomized, placebo-controlled trial compared the effects of individualized homeopathic medicinal products (IHMPs) and placebo after 4 months of intervention in patients with chronic low-back pain (LBP).
- the small sample size might have the result unreliable;
- the marginal level of statistical significance;
- the fact that 5+5+8+13=31 and not 30;
- the fact that the study originated from India where hardly any negative studys of homeopathy see the light of day;
- the fact that allmost all of the many authors of this paper are affiliated with homeopathic institutions;
- the existance of a strangely similar study that has recently reported largely negative results.
I am sure you remember Didier Raoult:
- Didier Raoult’s research is being called into question
- Didier Raoult and the hydroxychloroquine controversy ( part 1 )
- A census of untruths about chloroquine ( part 2 )
- HYDROXYCHLOROQUINE: This is NOT a Hollywood blockbuster ( Part 3)
Raoult has been banned from practising medicine for two years, and his ‘landmark study’ on hydroxychloroquine as a treatment for Covid-19 has been retracted. But, as the French magazine ‘LE POINT’ reported, he can’t stop himself from producing BS. On the ‘Magnifiscience’ website, the name of the cosmetics company in which he is a partner, we learn that (my translation):
Magnifiscience, the alternative to injections and facelifts!
Science at the service of skin health
Discover a range that smoothes the skin, reduces wrinkles and fine lines, while plumping and firming for a more radiant complexion.
Our skin care products work deep down to improve the skin’s natural composition. They stimulate the production of collagen, elastin and hyaluronic acid, while moisturising, optimising cell renewal and strengthening the skin’s barrier.
A molecular innovation that redefines the boundaries of science.
Scientific Cosmetics
At Magnifiscience, we push back the boundaries of beauty by combining the power of science with cosmetic innovation.
Our formulas are the result of advanced biomedical research, combining high-performance active ingredients to stimulate skin regeneration, protect against external aggressors and slow down the visible signs of ageing.
Each skin care product is designed to work in depth to deliver proven, visible and long-lasting results.
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For 75 euros per 60 ml, LE POINT explains, the Tonitence 1 and Tonitence 2 contain DRNB7 and DRNB8 ‘powerful active ingredient’ complexes. These acronyms are based on the initials of the partners: Didier Raoult and Nina Basri, a ‘specialist in the formulation of cosmetic active ingredients’. Her LinkedIn profile shows no studies or degrees in pharmacy or dermatology, but a series of company start-ups in beauty products. A Forbes Brand stories advertorial explains that her vocation was born ‘from the observation of a curious little girl: the powers of water. Since most of the human bodý is made up of water, Nina Basri saw this as a lever for action.’ Water is indeed present in both creams. It’s even their main ingredient. In addition to water, there are mainly nourishing sunflower and safflower oils. For hydration, there’s squalane, but no hyaluronic acid or even glycerine; they chose propylene glycol, which is less effective. For 75 euros for 60 ml, you’d expect something better. Vitamin C is also present, albeit indirectly, via orange extract, and in low doses. The formula also contains a number of active plant ingredients, including extracts of ginseng, apple… and ‘garlic bulb and onion.
In addition to the AMAP basket, which, let’s be fair, may contain small doses of exfoliating fruit acids and antioxidant vitamins and polyphenols, there’s a good ladleful of polymers that deposit a film on the skin: hydroxyethyl acrylate/Sodium acryloyldimethyl taurate copolymer and cetearyl dimethicone crosspolymer, as well as silicone (dimethicone), which also forms a film. The result is a temporary, mechanical filling effect that disappears when the make-up is removed. More worryingly, the cream contains Benzyl Alcohol and Tetramethyl Acetyloctahydronaphthalenes, which (like garlic and onion) are potentially allergenic.
_________________________
So, what about Raoult’s/Magnifiscience’s dermatological claims that their creams:
- reduce wrinkles,
- reduce fine lines,
- improve the skin’s natural composition,
- stimulate the production of collagen, elastin and hyaluronic acid,
- optimise cell renewal,
- strengthen the skin’s barrier,
- stimulate skin regeneration,
- protect against external aggressors ,
- slow down the visible signs of ageing?
Any evidence?
As far as I can see, no!
Around the year 2000, we thought to have eradicated measles. But, thanks to quacks like Andrew Wakefield and charlatans like Robert F. Kennedy Jr., measles are back. The latest measles case count in Texas represents merely a fraction of the true number of infections. Health officials suspect 200 to 300 people in West Texas are infected but untested, and therefore not part of the state’s official tally.
A request for comment from Kennedy about the outbreak received no response!!!
The Centers for Disease Control and Prevention (CDC) has sent approximately 2,000 doses of the MMR vaccine to Texas health officials at their request. However, most doses so far are being accepted by partially vaccinated kids to boost their immunity, rather than the unvaccinated. The Texas Tribune reported that vaccine exemptions have increased nearly annually over the last decade. Pro-vaccine groups such as The Immunization Partnership are finding it more challenging to stop mostly Republican lawmakers from pushing across “vaccine-choice” legislation.
- Historic TB outbreak a wake-up call for US policy makers
- Trump and Kennedy fire 5,200 HHS workers and gut the Epidemic Intelligence Service
- The New Mexico Department of Health declared a measles outbreak in a southeastern New Mexico county.
- Bird flu: Warning as elderly woman infected in Wyoming and cat cases confirmed
- Tuberculosis outbreak in Kansas among largest in US history.
THANK YOU, US VOTERS!
